The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 2024
Meta AnalysisCoronary artery bypass grafting versus medical therapy in patients with stable coronary artery disease: An individual patient data pooled meta-analysis of randomized trials.
It is unclear whether coronary artery bypass grafting (CABG) improves survival compared with medical therapy (MT) in patients with stable coronary artery disease (CAD). The aim of this analysis was to perform an individual-patient data-pooled meta-analysis of contemporary randomized controlled trials that compared CABG and MT in patients with stable CAD. ⋯ In patients with stable CAD, initial allocation to CABG was associated with greater periprocedural risk of death but improved long-term survival compared with MT. The survival advantage for CABG became significant after the fourth postoperative year and was particularly pronounced in younger and non-White patients.
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J. Thorac. Cardiovasc. Surg. · Mar 2024
Multicenter StudyTranscatheter mitral valve implantation versus conventional redo surgery for degenerated mitral valve prostheses and rings in a multicenter registry.
Degeneration of mitral prostheses/rings may be treated by redo surgery, and, recently, by transcatheter valve-in-valve/ring implantation. This multicenter registry presents results of transcatheter valve-in-valve and repeat surgery for prostheses/rings degeneration. ⋯ In both groups, observed mortality was less than predicted. Redo surgery enabled treatment of concomitant conditions, such as atrial fibrillation or TR. TR was shown to be a predictor of total, 30-day, and midterm mortality in both groups.
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J. Thorac. Cardiovasc. Surg. · Mar 2024
Textbook outcome: A novel metric in heart transplantation outcomes.
Assessing heart transplant program quality using short-term survival is insufficient. We define and validate the composite metric textbook outcome and examine its association with overall survival. ⋯ Textbook outcome is an alternative means of examining heart transplant outcomes and is associated with long-term survival. The use of textbook outcome as an adjunctive metric provides a holistic view of patient and center outcomes.
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J. Thorac. Cardiovasc. Surg. · Mar 2024
Robotic degenerative mitral repair: Factors associated with intraoperative revision and impact of mild residual regurgitation.
National registry data show wide variability in degenerative mitral repair rates and infrequent use of intraoperative repair revision to eliminate residual mitral regurgitation (MR). The consequence of uncorrected mild residual MR is also not clear. We identified factors associated with intraoperative revision of degenerative mitral repair and evaluated long-term effects of intraoperative mild residual MR. ⋯ A near 100% repair rate with acceptable durability may be achieved safely with intraoperative revision of postrepair residual MR. Mild residual MR was independently associated with reduced survival, worse freedom from more-than-moderate MR, and worse freedom from mitral reintervention at 8-year follow-up.
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J. Thorac. Cardiovasc. Surg. · Mar 2024
Outcomes following successful decannulation from extracorporeal life support for cardiogenic shock.
Although extracorporeal life support (ECLS) has increasingly been used for the treatment of patients with cardiogenic shock (CS), the outcomes of those successfully weaned from support remain poorly defined. ⋯ Successful decannulation can be achieved in a significant proportion of patients treated with ECLS for CS but does not guarantee survival to hospital discharge. However, 1-year survival of hospital survivors remains high and is comparable to patients bridged to transplant or a ventricular assist device.